Andrew Coates: Immigrants heavily subsidize Medicare

This week the prestigious journal Health Affairs published a new study that shows that "immigrants, particularly noncitizen immigrants, heavily subsidize Medicare." The lead author is Harvard-based Dr. Leah Zallman; her co-authors include co-founders of Physicians for a National Health Program, Drs. Steffie Woolhandler and David Himmelstein, among others.

The article's title summarizes its overall finding: “Immigrants contributed an estimated $115.2 billion more to the Medicare Trust Fund than they took out in 2002-09.” Appearing at a time when immigration has become a burning issue, the study has been welcomed by the media as a man-bites-dog story.

Across the United States and around the world news items have reported the study's findings. Perhaps this is because, regrettably, immigrants are still too often portrayed as freeloaders who don't deserve to compete for jobs and social benefits. It is one thing to recognize such attitudes as abject ignorance or old-fashioned bigotry. It is another to use the federal government's own data to quantify the contribution made by immigrants to one of the nation's most important social programs.

Dr. Zallman and her team found that in 2009 immigrants contributed $33.1 billion to Medicare Hospital Insurance Trust Fund, or 14.7 percent of all contributions, and were responsible for $19.3 billion of its expenditures, making a surplus contribution of $13.8 billion that year. Meanwhile contributions and expenditures by the U.S.-born left a $30.9 billion deficit.

As Dr. Woolhandler said of the study: “The numbers completely contradict the widely held misperception that immigrants are a drain on the health system. Reducing immigration would worsen Medicare’s financial woes.”

With Medicare woes also so prominent in the mainstream discussion, we might also note the irony that President Obama's administration has deported more immigrants per day than any of its predecessors. (The Washington Post mentioned earlier this month that over 1,100 human beings are deported from the United States daily.)

Immigrant rights groups have long pointed to the economic gain the U.S. could realize, both in extra revenue and avoided expenditures if deportations were halted and a path to legal residence and/or citizenship were opened. After all, the great majority of undocumented immigrants not only work, thus generating wealth, but are paid with a paycheck, with taxes removed from their pay like everyone else.

In the Health Affairs article the authors write: “Having ourselves witnessed immigrants dying needlessly because of lack of health care, we (and many of our colleagues) are motivated by the belief that all patients have a human right to health care. But economic concerns — including the worry that immigrants are driving up U.S. health care costs — have often dominated the debate over immigration."

It is my hope that the needs of human beings -- concerns about what kind of society we would like to see for our children and their children -- will come to dominate the discussion instead. Everyone living in the United States should have equitable access to comprehensive, high-quality health care, "everybody in, nobody out."

We all recognize that the intersection between immigration, health care and social policies in the United States has profound human consequences for millions of individuals. And we should also recall that the point of a democracy should be to provide the essentials for life and liberty for all of its inhabitants.

If we take a close look at the economics of immigration and the Medicare program, and take this study's findings to heart, we can see that the least we might do would be to base health and social policies upon the facts, not ignorance.

The article is available for free at the Health Affairs website until June 3.

Dr. Andrew Coates practices internal medicine in upstate New York. He is President of Physicians for a National Health Program.

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